Provider Demographics
NPI:1770526477
Name:CRUZ, LUCITA MENCHAVEZ (MD)
Entity type:Individual
Prefix:MRS
First Name:LUCITA
Middle Name:MENCHAVEZ
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12507 E ALONDRA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650
Mailing Address - Country:US
Mailing Address - Phone:562-802-2203
Mailing Address - Fax:562-262-2706
Practice Address - Street 1:12507 E ALONDRA BLVD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:562-802-2203
Practice Address - Fax:562-262-2706
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37419207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A374190Medicaid
A85011Medicare UPIN
CA00A374190Medicaid